<!DOCTYPE html>
<html>
<head>
	<title>Carepad Admin Center</title>
	<meta charset="utf-8">
	<meta name="viewport" content="width=device-width, initial-scale=1">
	
<!-- 	<link rel="shortcut icon" href="favicon.ico"> -->
	
	<link rel="stylesheet" href="../../assets/css/carePad.min.css" />
  	<link rel="stylesheet" href="../../assets/css/jquery.mobile.icons.min.css" />	
  	<link rel="stylesheet" href="http://code.jquery.com/mobile/1.4.1/jquery.mobile.structure-1.4.1.min.css" /> 
  
<!--     <link rel="stylesheet"  href="assets/css/jquery.mobile-1.4.1.min.css"> -->
    <link rel="stylesheet"  href="../../assets/css/custom.css">

<!--     <script src="assets/js/jquery.js"></script>  -->
    <script src="http://code.jquery.com/jquery-1.9.1.min.js"></script>
	<script type="text/javascript" src="../../assets/js/jquery.mobile-1.4.1.js"></script>
	<script type="text/javascript" src="../../assets/js/custom.js"></script>
	
	<style type="text/css">
		.ui-panel-dismiss-open.ui-panel-dismiss-position-right {
			right: 75%;
		}
	</style>
</head>
<body>

<div data-role="page" class="jqm-demos ui-responsive-panel"
	id="assessmentPage" data-title="Assessment">

	
	
<!-- header -->
<!-- 	<div data-role="header" > -->
<!-- 		<h3 class="ui-bar ui-bar-a" >Patient</h3> -->
<!--  		<a href="#nav-panel" data-icon="bars" data-iconpos="notext">Menu</a>  --> 
<!--  		<a href="#add-form" data-icon="search" data-iconpos="notext">Add</a> --> 
		
<!-- 	</div> -->
	
<div data-role="header" data-theme="k"  class="ui-btn-active ui-state-persist" data-position="fixed" >
	<h1>アセスメントシート</h1>
	<a href="#assessment-search-form" data-icon="search" data-theme="b" class="ui-btn-right">Search</a>
</div>

	
	<!-- /header -->

	
	

<!-- Start Content -->
	<div role="main" class="ui-content jqm-content jqm-fullwidth">

		<div class="ui-grid-a ui-responsive">
			<table cell-padding= "0" cell-spacing= "0" border="1" data-mini="true" style="width: 100%; border-collapse: collapse; text-align: center;">
			  <tr>
			    <th colspan="10" bgcolor="#507EA3"style="color: white;">ア セ ス メ ン ト シ ー ト</th>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">理由</td>
			    <td width="20%"  colspan="2"></td>
			    <td width="10%" bgcolor="#C8C8C8" align= "left" >作成者</td>
			    <td width="30%" colspan="3"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">作成日</td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">実施場所</td>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">更新者</td>
			    <td width="30%" colspan="3"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">更新日時</td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <th colspan="10" bgcolor="#A8D8FF" align="left">★基本情報</th>
			  </tr>
			  <tr>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">氏名（かな）</td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">生年月日</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">生年月日</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">年齢</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">性別</td>
			  </tr>
			  <tr>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">氏名</td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			  </tr>
			   <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left" rowspan="3">住所</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">郵便番号</td>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">都道府県</td>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" bgcolor="#C8C8C8" rowspan="3" align="left">電話番号</td>
			    <td width="20%" colspan="2" rowspan="3"> </td>
			  </tr>
				<tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">住所</td>
			    <td width="50%" colspan="5"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">建物名等</td>
			    <td width="50%" colspan="5"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left" rowspan="2">認定情報</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">要介護区分</td>
			    <td width="40%" colspan="4"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">状態</td>
			    <td width="30%" colspan="3"></td>
			  </tr>
			   <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">認定年月日</td>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">認定期間</td>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" >~</td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">自立度</td>
			    <td width="30%" colspan="3"></td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">認知症</td>
			    <td width="30%" colspan="3"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left" rowspan="4">被保険者情報等</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">介護保険</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">被保険者番号</td>
			    <td width="50%" colspan="5"></td>
			  </tr>
			  <tr>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">医療保険</td>
			    <td width="70%" colspan="7"></td>
			  </tr>
			  <tr>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">身体障害者手帳</td>
			    <td width="30%" colspan="3"></td>
			    <td width="10%" style="border-right-color:#D8D8D8;"></td>
			    <td width="10%" align="left" >種</td>
			    <td width="10%" style="border-right-color:#D8D8D8;"></td>
			    <td width="10%" align="left">種</td>
			  </tr>
			  <tr>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">生活保護</td>
			    <td width="10%"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">受給者番号</td>
			    <td width="20%" colspan="2" ></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" >負担者番号</td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left" rowspan="2">利用情報</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">初回利用日</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" >利用日</td>
			    <td width="60%" colspan="6">
				    <table style="width: 100%; border-collapse: collapse">
					  <tr>
					    <td style="border-right:1px solid black; border-right-color: #D8D8D8 "><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-1" id="checkbox-1" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-1">月</label></fieldset></td>
			          	<td style="border-right:1px solid black; border-right-color: #D8D8D8 "><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-2" id="checkbox-2" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-2">火</label></fieldset></td>
			          	<td style="border-right:1px solid black; border-right-color: #D8D8D8 "><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-3" id="checkbox-3" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-3">水</label></fieldset></td>
			          	<td style="border-right:1px solid black; border-right-color: #D8D8D8 "><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-4" id="checkbox-4" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-4">木</label></fieldset></td>
			          	<td style="border-right:1px solid black; border-right-color: #D8D8D8 "><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-5" id="checkbox-5" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-5">金</label></fieldset></td>
			          	<td style="border-right:1px solid black; border-right-color: #D8D8D8 "><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-6" id="checkbox-6" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-6">土</label></fieldset></td>
			          	<td><fieldset data-role="controlgroup" data-mini="true"  data-type="horizontal" data-role="fieldcontain"><input type="checkbox" name="checkbox-7" id="checkbox-7" data-mini="true"  class="custom" /><label data-mini="true" for="checkbox-7">日</label></fieldset></td>
					  </tr>
					</table>
			    </td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2"></td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" > 提供時間</td>
			    <td width="60%" colspan="6">
				    <table style="width: 100%; border-collapse: collapse">
					  <tr>
					    <td style="border-right: 1px solid black; border-right-color: #D8D8D8;"  width="30%" colspan="3"></td>
			          	<td style="border-right: 1px solid black; border-right-color: #D8D8D8;" width="10%" >~</td>
			          	<td width="30%" colspan="3"></td>
					  </tr>
					</table>

			    </td>
			  </tr>
			  <tr>
			    <td width="60%" bgcolor="#C8C8C8" align="left" colspan="6">職歴・生活歴・利用動機</td>
			    <td width="40%" bgcolor="#C8C8C8" align="left" colspan="4">既往歴</td>
			  </tr>
			  <tr>
			    <td width="60%" colspan="6">&nbsp</td>
			    <td width="40%" colspan="4"></td>
			  </tr>
			   <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left" rowspan="7">緊急連絡先</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left">続柄</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">氏名</td>
			    <td width="30%" bgcolor="#C8C8C8" align="left" colspan="3">住所</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" >同居</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">電話/メール</td>
			  </tr>
			  <tr>
			    <td width="10%" rowspan="2"></td>
			    <td width="20%" colspan="2" rowspan="2"></td>
			    <td width="30%" colspan="3" rowspan="2"></td>
			    <td width="10%" rowspan="2"></td>
			    <td width="20%" colspan="2">&nbsp</td>
			  </tr>
			   <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			  </tr>
			  <tr>
			    <td width="10%" rowspan="2"></td>
			    <td width="20%" colspan="2" rowspan="2"></td>
			    <td width="30%" colspan="3" rowspan="2"></td>
			    <td width="10%" rowspan="2"></td>
			    <td width="20%" colspan="2">&nbsp</td>
			  </tr>
			   <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			  </tr>
			  <tr>
			    <td width="10%" rowspan="2"></td>
			    <td width="20%" colspan="2" rowspan="2"></td>
			    <td width="30%" colspan="3" rowspan="2"></td>
			    <td width="10%" rowspan="2"></td>
			    <td width="20%" colspan="2">&nbsp</td>
			  </tr>
			   <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			  </tr>
			   <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left" rowspan="11">関係支援先</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">施設名</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" >担当者</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" >職種</td>
			    <td width="10%" bgcolor="#C8C8C8" align="left" >カテゴリ</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">電話番号</td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">メール</td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="20%" colspan="2">&nbsp</td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="10%" ></td>
			    <td width="20%" colspan="2"></td>
			    <td width="20%" colspan="2"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">備考</td>
			    <td width="90%" colspan="9"></td>
			  </tr>
			  <tr>
			    <th colspan="10" bgcolor="#A8D8FF" align="left">★健康状態</th>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">内服</td>
			    <td width="90%" colspan="9"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">アレルギー</td>
			    <td width="90%" colspan="9"></td>
			  </tr>
			   <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">バイタル</td>
			    <td width="30%" colspan="3"></td>
			    <td width="20%" bgcolor="#C8C8C8" align="left" colspan="2">バイタルメモ：</td>
			    <td width="40%" colspan="4"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">留意点</td>
			    <td width="90%" colspan="9"></td>
			  </tr>
			  <tr>
			    <td width="10%" bgcolor="#C8C8C8" align="left">特記事項</td>
			    <td width="90%" colspan="9"></td>
			  </tr>
			  <tr>
			    <td width="100%" colspan="10">さんだん花ガーデン デイサービス</td>
			  </tr>

			  </table>
		</div>
	</div>
	<!-- /content -->

	
	
	<!-- search Panel	 -->
	
	<div data-role="panel" data-position="right"  data-display="overlay"
		data-theme="a" id="assessment-search-form" style="width: 75%;">
				<div data-role="fieldcontain>
					<form action="form.php" method="post" data-mini="true">
						<div data-role="fieldcontain" data-mini="true">
						    <label for="name" data-theme="f" data-mini="true">氏名:</label>
						    <input type="text" data-theme="f" name="search-scs" data-mini="true" id="text-hcs-id" value="" placeholder="">
						    </br></br>
						    <label for="name" data-theme="f" data-mini="true">住所:</label>
						    <input type="text" name="search-scs" data-theme="f" data-mini="true" id="text-hcs-id" value="" placeholder="">
						    </br></br>
						    <label for="name" data-theme="f" data-mini="true">ID:</label>
						    <input type="text" name="search-scs" data-theme="f" data-mini="true" id="text-hcs-id" value="" placeholder="">
						    </br></br>
						</div> 
						<div data-role="fieldcontain">
						    <fieldset data-role="controlgroup"  >
							   <input type="checkbox" name="checkbox-1" id="checkbox-1" data-theme="f" data-mini="true" class="custom"/>
							   <label for="checkbox-1" data-theme="f" data-mini="true">有効な利用者のみ表示する</label>
							    <input type="checkbox" name="checkbox-2" id="checkbox-2" data-theme="f" data-mini="true" class="custom" />
							   <label for="checkbox-2" data-mini="true">過去のシートも表示する</label>
							    <input type="checkbox" name="checkbox-3" id="checkbox-3" data-theme="f" data-mini="true" class="custom" />
							   <label for="checkbox-3" data-theme="f"  data-mini="true">アセスメントシートが無い利用者も表示する</label>
							   
						    </fieldset>
						</div>
						<a href="#" data-role="button" data-mini="true" data-theme="j" data-icon="search">S e a r c h</a>
					</form>
				</div>
				
			<div class="ui-body ui-body-h ui-corner-all" style="height: 450px; overflow: auto;" >
			<table data-role="table" id="table-custom-2"
					data-mode="columntoggle" data-mini="true"
					class="ui-body-d ui-shadow table-stripe ui-responsive"
					data-column-btn-theme="b" data-column-btn-text=" Select "
					data-column-popup-theme="a"
					>
					<thead>
						<tr class="ui-bar-h">
							<th data-priority="2">Id</th>
							<th>Name</th>
							<th data-priority="3">Sex</th>
							<th data-priority="1"><abbr>Assment No</abbr></th>
							<th data-priority="5">HCS ID</th>
						</tr>
					</thead>
					<tbody>
						<tr>
							<th>1</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">藤本 明日</a>
							</td>
							<td>F</td>
							<td>8</td>
							<td>KANA-000001</td>
						</tr>

						<tr>
							<th>2</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">新垣 さとみ</a>
								
								</td>
							<td>F</td>
							<td>11</td>
							<td>KANA-000002</td>
						</tr>
						<tr>
							<th>3</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">平野 ケンイチ</a>
								</td>
							<td>M</td>
							<td>3</td>
							<td>LKAN-000001</td>
						</tr>

						<tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr>
						<tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr><tr>
							<th>4</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>6</td>
							<td>LKAN-000002</td>
						</tr>

						<tr>
							<th>5</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>16</td>
							<td>LKAN-000008</td>
						</tr>
						
						<tr>
							<th>6</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>26</td>
							<td>LKAN-000023</td>
						</tr>
						
						<tr>
							<th>7</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>M</td>
							<td>32</td>
							<td>LKAN-000009</td>
						</tr>
						
						<tr>
							<th>8</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>M</td>
							<td>11</td>
							<td>LKAN-000021</td>
						</tr>
						
						<tr>
							<th>9</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>M</td>
							<td>346</td>
							<td>LKAN-000048</td>
						</tr>
						
						<tr>
							<th>10</th>
							<td><a href="#frmContactEdit" data-rel="popup"
								data-transition="slideup">梅村 美菜</a>
								</td>
							<td>F</td>
							<td>14</td>
							<td>LKAN-000034</td>
						</tr>
					</tbody>
				</table>
		</div>
	</div>
	<!-- /panel -->
	
	
	
	<div data-role="footer" data-theme="k" data-position="fixed">		
		<div data-role="navbar">
			<ul>
				<li><a href="home.php" data-icon="user" data-role="button" data-ajax="false" >利用者一覧</a></li>
				<li><a href="assessment.php" data-icon="bullets" data-role="button" class="ui-btn-active ui-state-persist" data-ajax="false">アセスメントシート</a></li>
				<li><a href="dragdrop.php" data-icon="grid" data-role="button">週間利用者一覧</a></li>
				<li><a href="last.php" data-icon="grid" data-role="button">実施項目設定</a></li>
				<li><a href="final.php" data-icon="grid" data-role="button">通所介護記録一覧</a></li>
				
			</ul>
		</div><!-- /navbar -->
	</div><!-- /footer -->
	
	<div data-role="popup" id="frmContactEdit" data-theme="b">
		<div class="ui-grid-a ui-responsive">
			<table cell-padding= "0" cell-spacing= "0" border="1" data-mini="true" style="width: 100%; border-collapse: collapse; text-align: center;">
				  <th width="70%" bgcolor="#507EA3" colspan="8">Contact Edit</th>
				  <tr>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" rowspan="4">理由</td>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" >理由</td>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" >作成者</td>
					 <td width="20%" bgcolor="#A8D8FF" style="color: black;" colspan="2" >理由</td>
					 <td width="30%" bgcolor="#A8D8FF" style="color: black;" colspan="3" >作成日</td>
				 </tr>
				   <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" >作成者</td>
					 <td width="20%" bgcolor="#FFFFFF" style="color: black;" align="left" colspan="2" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" align="left" colspan="3" >作成日</td>
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" >作成者</td>
					 <td width="20%" bgcolor="#FFFFFF" style="color: black;" align="left" colspan="2" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" align="left" colspan="3" >作成日</td>
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" >作成者</td>
					 <td width="20%" bgcolor="#FFFFFF" style="color: black;" align="left" colspan="2" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" align="left" colspan="3" >作成日</td>
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" rowspan="11">理由</td>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#A8D8FF" style="color: black;" colspan="3">作成者</td>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" >理由</td>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" >作成日</td>
					 <td width="10%" bgcolor="#A8D8FF" style="color: black;" >作成日</td>
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 <tr>
					 <td width="10%" bgcolor="#C8C8C8" style="color: black;" >理由</td>
					 <td width="30%" bgcolor="#FFFFFF" style="color: black;" colspan="3" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td>
					 <td width="10%" bgcolor="#FFFFFF" style="color: black;" align="left" ></td> 
				 </tr>
				 
				 
			</table>
			<div align="center" data-mini="true" style=" background: #FFFFFF ">
				<a href="#"  data-role="button" data-mini="true" data-inline="true" style="width: 42%;">Cancel</a>
				<a href="#" data-role="button" data-mini="true" data-inline="true" style="width: 42%; background-color :  #507EA3" >Save</a>
			</div>
		</div>
	
</div>



</body>
</html>